Burns: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.

Summary

Scald burns are the most common burn type in children who have been abused and the most common causative agent is tap water. Abusive scalds tend to be distributed on the buttocks, perineum, and lower extremities, with clear upper limits and scald symmetry especially when present on the lower extremities. In non-scald abusive burns contact burns are the most common. These burns tend to be distributed on the back, shoulders, and buttocks, with clearly demarcated edges often matching the object used.

The following systematic review evaluates the scientific literature on abusive and non-abusive burns in children published up until October 2016.

The review aimed to answer four questions:

• • What are the clinical and social features that distinguish intentional and accidental scalds in children?
  • What are the features of intentional non-scald burns?
  • What conditions mimic intentional burns?
  • How do you identify a burn due to neglect?

Key findings:

• • The prevalence of abusive burns is estimated to be 5.3% – 14% of children admitted to burns units highest for those aged 0 – 1 years
  • Children with abusive burns were found to be significantly younger than those with accidental burns. However when compared to children referred to child protection teams for all causes of physical abuse, those with burns were significantly older and more likely to be boys (66% vs. 56%)